Wednesday, April 17, 2013

UPDATES at end of story about nonprofit "sniffing" and Wash Post report on agents' worries.

In
preparation for the huge changes coming next year in healthcare
reform, moves are starting quietly about a small but crucial piece
for consumers – the role of people called “navigators.”

These
are the people – funded by the federal government – whose job
will be to help consumers negotiate the complicated new world of
exchanges, in which virtually everyone will be able to buy insurance
at group rates, regardless of age or preexisting conditions.

Santiago
Leon, a Miami health insurance broker who's highly active in
healthcare causes, reports that Florida will get about $5.8 million
in the first year to fund navigator programs.

Many
consumers will be interested in exploring what exchanges to have to
offer and at what price. That's true for the uninsured and for
employees who are clinging to jobs they don't like just because
they're guaranteed to get health coverage.

Their questions about the new exchanges are likely to be plentiful, particularly in the first year or two, and the Affordable Care Act has allocated money to helping consumers understand them.

Florida's
Legislature and governor never took action to have a state-controlled
exchange, and the state's residents will be signing up for one
designed by the federal government.

Even
so, the Florida Association of Health Underwriters is asking the
Legislature to craft legislation to deal with navigators.

“Navigators
are not insurance agents and HHS [Health
and Human Services]
clearly states that states cannot require navigators
to hold [an]
agent/producer
license,” the
association said in a press release.

“With
this in mind, we are recommending legislation that addresses the
qualifications of the navigator
and clearly differentiates their role from that of a licensed
insurance agent,” the
association said.

The
association's underlying fear is that a navigator might be a company
that gets federal funds to direct patients to its own products.

Leon
notes: “There can
be
more than one navigator for Florida, but at least one of them must be
a 'community
and consumer- focused nonprofit.'

At
present many Florida nonprofits in the healthcare sector are studying
the regs that navigators must meet – but it's unclear how many will
make formal bids.

Leon
says federal regs require entities who want to be navigators need to
become experts in eligibility and enrollment details, provide
information in a fair, accurate and impartial manner and conduct
public education campaigns to make people aware of the exchanges.

UPDATE:One
anonymous insider notes: “There
is a lot of sniffing around going on” among major Florida healthcare
nonprofits who are thinking of becoming navigators, but none have
announced as of yet and all are said to be looking at each other.

Much
more on the jockeying for regulations and bids for participation are
likely in coming months. The exchanges can start enrolling people in
October, for coverage that begins Jan. 1.

UPDATE:The
Washington Post reportsthat
the navigators are going to be a huge undertaking, with California
expected to need 21,000 advisers for its state alone. The Post
reports that some health agents groups are demanding legislation
holding navigators liable for bad advice on picking a plan, because
the agents fear that navigators may navigate business away from the
agents.

Much
more on the jockeying for regulations and bids for participation are
likely in coming months. The exchanges can start enrolling people in
October, for coverage that begins Jan. 1.